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UI Thesis Dipeolu IO Effect 2 Title EFFECT OF MOBILE-PHONE REMINDER TEXT MESSAGES ON MOTHERS’ KNOWLEDGE AND COMPLETION OF ROUTINE IMMUNISATION IN RURAL AREAS OF OYO STATE, NIGERIA BY ISAAC OLUWAFEMI DIPEOLU B.Ed., M.Ed. (Guid. & Counsel.), M.P.H. (Ibadan) MATRIC №: 69372 A THESIS IN THE DEPARTMENT OF HEALTH PROMOTION AND EDUCATION, SUBMITTED TO THE FACULTY OF PUBLIC HEALTH IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY OF THE UNIVERSITY OF IBADAN UNIVERSITY OF IBADAN LIBRARY February 2017 AFRICAN DIGITAL HEALTH REPOSITORYi PROJECT DEDICATION To all the victims of vaccine-preventable diseases and their caregivers UNIVERSITY OF IBADAN LIBRARY AFRICAN DIGITAL HEALTH REPOSITORYii PROJECT ABSTRACT Interventions aimed at promoting completion of Routine Immunisation (RI) in Nigeria have not yielded satisfactory results. Text Message Reminders (TMRs) through mobile phones have been used to promote adoption of innovations; however, its effectiveness in enhancing the completion of RI in rural areas has not been adequately investigated. This study was designed to evaluate the effects of TMRs on knowledge and completion of RI by Mothers of Infants (MI) in rural Local Government Areas (LGAs) in Oyo State, Nigeria. The adopted quasi-experimental design involved random selection of Ibarapa North (IN) and Kajola from the list of 12 rural LGAs with highest immunisation dropout rates. Ibarapa North and Kajola were randomly allocated to Intervention Group (IG) and Control Group (CG), respectively by balloting. Five Primary Health Care facilities in each LGA with RI services were randomly selected out of 10 facilities in each LGA. All consenting 179 MI in IG and 187 MI in CG who registered their children at the health facilities for RI in June 2014 were enrolled. Data were collected through Focus Group Discussion (FGD) among MI, Key Informant Interview (KII) among Health Workers (HWs), and an interviewer-administered questionnaire, which included a 25-point knowledge scale, questions on receipt of TMRs and RI appointment keeping. Knowledge Scores (KS) <13 and ≥13 were categorised as poor and good, respectively. Baseline results were used to design an intervention that involved disseminating TMRs to MI in IG thrice weekly for 10 months on the importance of RI and RI appointment keeping. A thematic approach was used to analyse qualitative data. Quantitative data were analysed using descriptive statistics, t-test and Chi-square test. Level of significance was at p=0.05. Respondents’ ages in IG and CG were 26.4±5.6 and 28.3±5.5 years, respectively. The highest level of education was high school among IG (65.2%) and CG (57.0%). The FGD participants had little knowledge of RI. Many participants in both groups supported the use of TMRs for promoting RI appointments among MI. The KII revealed that few HWs counselled RI defaulting mothers on adherence to complete RI. Majority of the IG UNIVERSITY(79.1%) received TMRs and OFamong this IBADANsub-group, 75.5% reportedly LIBRARY received TMRs often. Immunisation barriers listed by respondents in IG for not completing RI included busy schedules (24.4%), children’s ill health (16.7 %) and apathy (16.7%). Baseline KS AFRICAN DIGITAL HEALTH REPOSITORYiii PROJECT among IG and CG were 10.3±3.5 and 9.3±2.5, respectively, which increased significantly to 12.9±2.8 and 13.1±4.0 among IG and CG at Post-Intervention (PI). However, at PI, KS among IG was 12.9±2.8 and this was not significantly different from 13.1±4.0 among CG. Significantly, more MI in IG (77.4%) compared with those in CG (64.5%) completed RI. Percentage of completion of immunisation among IG was 87.1%, and this was significantly higher than the 56.7% among CG. Text message reminders were effective in improving knowledge and completion of routine immunisation among mothers of infants in Ibarapa North Local Government Area. Therefore, its use among frontline health workers is recommended. Keywords: Text message reminders, Immunisation-related knowledge, Immunisation barriers UNIVERSITY OF IBADAN LIBRARY AFRICAN DIGITAL HEALTH REPOSITORYiv PROJECT ACKNOWLEDGEMENTS First, I give my sincere thanks to my supervisor, a successful researcher and mentor, Professor Oladimeji Oladepo. He graciously accepted to supervise my PhD without any hesitation when I approached him. I appreciate all his contributions of time and ideas and his assistance in accessing funds that made my PhD experience fulfilling. In addition, I thank the Acting Head of Department, Dr Fredrick Oshiname, who offered very helpful scholarly insights into my work each time I discussed it with him. I equally appreciate the contribution of all other faculty in the Department of Health Promotion and Education - Professors Ademola Ajuwon and Oyedunni Arulogun, Drs. Oyediran Oyewole, Musibau Titiloye, Yetunde John-Akinola, Yimika Desmennu and Moji Oluwasanu - who out of no time created time to go through and commented on my post- field presentation, the result and the abstract section of my thesis. Special thanks to Prof. Nnodimele Atulomah and Dr Martina Ezeama for a load of electronic literature and supports I received from them. Those materials facilitated the review of the literature aspect of my thesis. Thanks to Messrs. Temitope Oyeyemi, Sam Akande and Tayo Adetunji also for working on the word processing and data entry aspect of the draft thesis. I would like to extend my gratitude to all mothers of infants who attended routine immunisation clinics in Ibarapa North and Kajola Local Government Areas between 2014 and 2015. They provided invaluable information that formed the basis of this thesis. I thank the research assistants and supervisors who worked with me during data collection. I would also like to thank Messrs. Nath Afolabi and Taiwo Abiona for their inputs during data analysis. I thank every other individual who assisted in coding, data entry or word processing. A special thanks to Chief Nursing Officer Rosemary Odega, University College Hospital, for her assistance those occasions I had health challenges in the course of this programme. She offered much assistance and ensured that I got quick medical attention at the hospital. UNIVERSITYThis research received funding OF from theIBADAN African Doctoral Dissertation LIBRARY Research Fellowship (ADDRF) award offered by the African Population and Health Research Center (APHRC) in partnership with the International Development Research Centre (IDRC) (Grant Number: 107508-001). Part of this research was funded by a MEPIN AFRICAN DIGITAL HEALTH REPOSITORYv PROJECT Year 05 Mentored Research Grant offered by Medical Education Partnership Initiative in Nigeria (MEPIN) project funded by Fogarty International Centre, the Office of AIDS Research, and the National Human Genome Research Institute of the National Institute of Health, the Health Resources and Services Administration (HRSA) and the Office of the U.S. Global AIDS Coordinator under Award Number R24TW008878. I would like to convey my heartfelt thanks to my office, the Department of Health Promotion and Education, for financial support. My office also provided me with an enabling environment to combine work with doctoral research. Without these supports and financial help, it would not have been possible for me to pursue and complete this PhD timely and successfully. I am greatly indebted to my devoted wife, Princess, my daughter, Darlingtina and my son, Reagan. Their love and support without much complaint or regret enabled me to complete this doctoral programme. Filling the gap my absence from home often created was not an easy task for my wife. Yet, she took every responsibility and endured all forms of hardships and loneliness to take care of my children. I owe my every achievement to them all. Above all, I owe it all to Almighty God for granting me the wisdom, health and strength to undertake this research successfully. Oluwafemi Dipeolu February 2017 UNIVERSITY OF IBADAN LIBRARY AFRICAN DIGITAL HEALTH REPOSITORYvi PROJECT CERTIFICATION I certify that this work was carried out by Isaac Oluwafemi DIPEOLU in the Department of Health Promotion and Education, University of Ibadan. ………………………………………………………………………….. Supervisor Oladimeji Oladepo B.Sc., M.P.H., PhD (Ibadan), FRSPH (UK) Professor, Department of Health Promotion and Education, Faculty of Public Health, College of Medicine University of Ibadan, Nigeria UNIVERSITY OF IBADAN LIBRARY AFRICAN DIGITAL HEALTH REPOSITORYvii PROJECT TABLE OF CONTENTS Title .................................................................................................................................. i DEDICATION ................................................................................................................ ii ABSTRACT ................................................................................................................... iii ACKNOWLEDGEMENTS ............................................................................................ v CERTIFICATION ........................................................................................................ vii TABLE OF CONTENTS ............................................................................................. viii LIST OF TABLES ........................................................................................................ xii LIST OF FIGURES ..................................................................................................... xiv LIST OF APPENDIXES ..............................................................................................
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